Surgical access device with fascial closure system

ABSTRACT

A surgical access device is disclosed and includes a housing, a cannula, a guide, and an expandable member. The cannula extends distally from the housing and defines a longitudinal axis. A wall of the cannula includes a first slot defined therein. The guide is engagable with the housing and defines a first channel. The first channel is disposed at a non-parallel angle relative to the longitudinal axis. The expandable member is disposed adjacent a distal portion of the cannula and is transitionable between a collapsed configuration and an expanded configuration. A first surgical instrument is insertable through the first channel of the guide and through the first slot of the cannula.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalPatent Application Ser. No. 62/739,909 filed Oct. 2, 2018, the entiredisclosure of which is incorporated by reference herein.

BACKGROUND Technical Field

The present disclosure relates to a surgical apparatus. Moreparticularly, the present disclosure relates to a surgical access devicethat can maintain its position relative to the patient during a surgicalprocedure. The surgical access device also includes a system tofacilitate fascial closure.

Background of Related Art

In minimally invasive surgical procedures, including endoscopic andlaparoscopic surgeries, a surgical access device permits theintroduction of a variety of surgical instruments into a body cavity. Asurgical access device (e.g., a cannula) is introduced through anincision in tissue to provide access to an underlying surgical site inthe body. The cannula is introduced through the incision with anobdurator disposed in the passageway of the cannula. The obturator canhave a blunt or sharp tip for penetrating tissue. The obturator isremoved to permit introduction of surgical instrumentation through thesurgical access device to perform the surgical procedure.

These procedures are performed while the abdominal cavity is inflatedwith a pressurized gas. To maintain the position of the surgical accessdevice with respect to the body wall, the access device can include ananchor near its distal end. To help maintain the position of thesurgical access device with respect to the body wall, an inflatableballoon disposed near a distal end of the surgical access device can beused. The access device is positioned so that the balloon is disposedinside the patient's body, anchoring the access device. Inflating such aballoon while the surgical access device is within the body helpsprevent the surgical access device from undesired movement with respectto the body.

Additionally, following such surgical procedures, the incision isclosed. A suture and needle is used to close the fascia and othertissue, using a separate instrument. It may be helpful to provide asingle surgical access device that can be maintained in its positionrelative to the body, and that can allow a device to pass therethroughto close the incision. It may also be helpful to provide a singlesurgical access device that can be maintained in its position withoutthe need to remove the surgical access device and/or desufflate theworking space prior to facial closure.

SUMMARY

The present disclosure relates to a surgical access device including ahousing, a cannula, a guide, and an expandable member. The cannulaextends distally from the housing and defines a longitudinal axis. Awall of the cannula includes a first slot defined therein. The guide isengagable with the housing and defines a first channel. The firstchannel is disposed at a non-parallel angle relative to the longitudinalaxis. The expandable member is disposed adjacent a distal portion of thecannula and is transitionable between a collapsed configuration and anexpanded configuration. A first surgical instrument is insertablethrough the first channel of the guide and through the first slot of thecannula.

In disclosed embodiments, the wall of the cannula may include a secondslot defined therein. The second slot may be longitudinally offset fromthe first slot.

It is also disclosed that the cannula may include an inner tube and anouter tube. It is also disclosed that the inner tube may define thefirst slot, and the outer tube may define an outer tube slot. The firstslot and the outer tube slot may be aligned with each other. Inembodiments, the surgical access device may include a film covering atleast one of the first slot and the outer tube slot. It is furtherdisclosed that the film may be adhered to a recessed surface of at leastone of the inner tube and the outer tube.

In embodiments of the present disclosure, the surgical access device mayinclude at least one channel disposed within the wall of the cannula. Itis further disclosed that the at least one channel may extend between aproximal portion of the cannula and the distal portion of the cannula,and that the at least one channel may be radially offset from the firstslot.

In disclosed embodiments, the expandable member may include a fixationmesh or a balloon fixation device.

It is further disclosed that in embodiments where the cannula includesan inner tube and an outer tube, the expandable member may include aballoon fixation device. It is also disclosed that the housing mayinclude an inflation port disposed in fluid communication with theballoon fixation device. It is further disclosed that there may be aspace between the inner tube and the outer tube that is disposed influid communication with the inflation port and with the balloonfixation device.

The present disclosure also relates to a method of performing a surgicalprocedure including inserting a portion of a cannula through an incisionin a patient, transitioning an expandable member of the cannula from acollapsed configuration to an expanded configuration, inserting a firstsurgical instrument along a longitudinal axis through an aperture of thecannula, performing a surgical task with the first surgical instrument,inserting a second surgical instrument along a second axis which isdisposed at a non-parallel angle relative to the longitudinal axis,inserting a distal tip of the second surgical instrument through a slotwithin a wall of the cannula, and performing a surgical task with thesecond surgical instrument.

In disclosed embodiment, the method may include removing the firstsurgical instrument from the aperture of the cannula prior to insertingthe second surgical instrument along the second axis.

It is further disclosed that the method may include urging the distaltip of the second surgical instrument through a film covering the slotwithin the wall of the cannula.

Additionally, the method may include transitioning the expandable memberof the cannula from the expanded configuration to the collapsedconfiguration.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are illustrated hereinwith reference to the accompanying drawings, wherein:

FIG. 1 is a perspective view of a surgical access device including aballoon fixation device of the present disclosure;

FIG. 1A is a perspective view of the surgical access device of FIG. 1with a guide separated from a housing of the surgical access device;

FIG. 2 is a perspective view of the surgical access device of FIG. 1including a suture passer inserted therethrough;

FIG. 3 is a side view of the surgical access device of FIG. 1 includinga suture passer inserted therethrough;

FIG. 4 is a perspective view of an inner tube and an outer tube of thesurgical access device of FIGS. 1-3 in accordance with an embodiment ofthe present disclosure;

FIG. 5 is a perspective view of an inner tube and an outer tube of thesurgical access device of FIGS. 1-3 in accordance with anotherembodiment of the present disclosure;

FIG. 5A is an enlarged view of the area of detail indicated in FIG. 5;

FIG. 6 is a perspective view of a distal end of a cannula of a surgicalaccess device in accordance with another embodiment of the presentdisclosure;

FIG. 7 is a perspective view of a surgical access device including afixation mesh device in accordance with another embodiment of thepresent disclosure;

FIG. 7A is a perspective view of an inner tube of the surgical accessdevice of FIG. 7;

FIG. 8 is a perspective view of the surgical access device of FIG. 7including a suture passer inserted therethrough;

FIG. 9 is a perspective view of a surgical access device in accordancewith another embodiment of the present disclosure including a suturepasser extending therethrough and illustrating a fixation mesh in adeployed configuration; and

FIG. 10 is a side view of a distal end of the surgical access device andsuture passer of FIG. 9 illustrating the fixation mesh in an undeployedconfiguration.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Embodiments of the presently disclosed surgical access device aredescribed in detail with reference to the drawings, wherein likereference numerals designate corresponding elements in each of theseveral views.

Various embodiments of a surgical access device are described herein.Generally, the surgical access devices include a fixation device (e.g.,a balloon fixation device or a fixation mesh device) configured toengage tissue to help maintain the surgical access device in itsposition relative to the body during use, and include a fascial closuresystem which creates an efficient way of closing the incision throughwhich the surgical access device entered the body. FIGS. 1-6 illustrateembodiments of a surgical access device including a balloon fixationdevice, and FIGS. 7-10 illustrate embodiments of a surgical accessdevice including a fixation mesh device. It is envisioned that thesurgical access devices disclosed herein are useful in Hassontechniques, as well as those using blunt, bladeless, bladed and/oroptical obturators where the surgical access device is used to gainentry to the abdomen for laparoscopy, for example.

With initial reference to FIGS. 1-3, a surgical access device 100 isshown. Surgical access device 100 includes a housing 109 and a cannula200 extending distally from housing 109. The cannula 200 defines alongitudinal axis “A-A.” A guide or suture guide 110 is attached to orconfigured to selectively engage the housing 109. The guide has an upperflange and a tube extending from the flange. The guide 110 flange andtube define a first channel 112 and a second channel 114 extendingtherethrough (FIG. 2), and includes a seal 115 (e.g., an O-ring) (FIG.1A) on the tube configured to engage an inner wall of cannula 200 forestablishing a fluid-tight boundary in the cannula that maintains apneumoperitoneum in a patient. The access device 100 has an instrumentseal housing that is removed from the housing 109 before the guide isattached to the access device 100. The housing 109 includes a zeroclosure seal, such as a duckbill seal, for sealing the passageway of thecannula when no instrument is inserted through it.

Surgical access device 100 also includes an expandable member or balloonfixation device 300 disposed adjacent a distal end of cannula 200, andat least one slot 250 defined in the cannula 200. As shown in FIGS. 2and 3, a suture passer “SP” (for example) is insertable through one ofchannels 112, 114 of guide 110 and through one of slots 250 of cannula200. Generally, suture passers “SP” are configured to pass a suturethrough a cannula 200 and to tissue adjacent an incision, for instance.

Additional description of an access device, guide, and suture passer canbe found in U.S. Patent Application Publication No. 2015/0038793entitled “DEVICES, SYSTEMS, AND METHODS FOR PROVIDING SURGICAL ACCESSAND FACILITATING CLOSURE OF SURGICAL ACCESS OPENINGS”, the entirecontents of which being hereby incorporated by reference herein. Asealing member is disposed over the slot 250 in the cannula and can beformed from an elastomeric film or tube disposed over the slot 250.

Further details of various embodiments of surgical access device 100 arediscussed below with reference to FIGS. 4-6. FIG. 4 illustrates anembodiment of a cannula 200 a for use with surgical access device 100.Cannula 200 a includes an inner tube 220 a and an outer tuber 240 a.Inner tube 220 a is configured to fit within outer tube 240 a, andincludes at least one slot 230 a defined therein. In embodiments, innertube 220 a includes two slots 230 a that are 180° offset from eachother. In particular, slot 230 a is defined by a recessed surface 222 aof an outer wall of inner tube 220 a. While slot 230 a is oval-shaped inthe accompanying figures, slot 230 a may be any regular or irregularshape, such as circular, rectangular, etc. Further, a film 235 a coversslot 230 a and may be affixed to recessed surface 222 a of inner tube220 a by welding (e.g., ultrasonic welding), for instance, or adhesivebonding. It is envisioned that the outer wall of inner tube 220 a andfilm 235 a cooperate to form a flush or nearly flush surface.

With continued reference to FIG. 4, outer tube 240 a is configured tofit over inner tube 220 a, has a shorter length than inner tube 220 a,and includes at least one slot 250 a defined therein. As shown in FIG.3, outer tube 240 a includes two slots 250 a that are 180° offset fromeach other. Each slot 250 a is shaped to correspond with slot 230 a ofinner tube 220 a, is covered by a film 255 a, and is configured toradially and longitudinally align with slot 230 a of inner tube 220 awhen outer tube 240 a and inner tube 220 a are engaged.

Balloon 300 (FIGS. 1-3) is mounted adjacent a distal end of cannula 200a and is transitionable between a collapsed or deflated configurationand an expanded or inflated configuration. In particular, a distal end302 of balloon 300 is mounted to or adjacent a distal end 221 a of innertube 220 a, and a proximal end 304 of balloon 300 is mounted to oradjacent a distal end 241 a of outer tube 240 a (FIGS. 1 and 4). In thisarrangement, air (or another inflation medium) is forced from aninflation port 111 (FIGS. 1-3), between inner tube 220 a and outer tube240 a of cannula 200 a, out distal end 241 a of outer tube 240 a (distalend 241 a of outer tube 240 is disposed proximally of distal end 221 aof inner tube 220 a), and into balloon 300 to inflate balloon 300. Todeflate balloon 300, the inflation medium is removed from balloon 300,between inner tube 220 a and outer tube 240 a of cannula 200 a, and outof inflation portion 111. Films 235 a and 255 a help ensure the air/gasfrom a pressurized environment within the patient does not escapethrough inner tube 220 a or outer tube 240 a of cannula 200 a. Theballoon can be formed as disclosed in U.S. application Nos. 62/453,557and/or 62/568,497, the entire disclosures of each of which are herebyincorporated by reference herein.

In use, a distal portion of cannula 200 a is positioned within a patient(e.g., in the abdominal cavity), balloon 300 is inflated throughinflation port 111 to help secure cannula 200 a with respect to thepatient, and a surgical procedure is performed (e.g., by a surgicalinstrument inserted through a lumen 270 a (FIG. 3) of cannula 200 a).Following the surgical procedure, the surgical instrument is removedfrom lumen 270 a, and the instrument seal housing is removed fromengagement with housing 109, and a portion of guide 110 is insertedthrough cannula 200 a. Next, a suture passer “SP” (FIGS. 2 and 3) isinserted through first channel 112 or second channel 114 of guide 110and at a non-parallel angle with respect to the longitudinal axis “A-A.”Thus, the suture passer “SP” follows a different pathway from thesurgical instruments previously used. First channel 112 is angled suchthat a distal tip of the suture passer “SP” is moved through a neck ofballoon 300 and toward slot 230 a of inner tube 220 a. Urging the suturepasser “SP” distally forces the distal tip of the suture passer “SP” topierce film 235 a covering slot 230 a of inner tube 220 a, to piercefilm 255 a covering slot 250 a of outer tube 240 a, and to extend outfrom the outer tube 240 a. Depending on the shape, size and/ororientation of balloon 300, a physician may opt to insert suture passer“SP” into guide 110 and to patient tissue following deflation of balloon300 to help prevent the distal tip of the suture passer “SP” frominterfering with balloon 300. After the distal tip of the suture passer“SP” is positioned at tissue, the suture passer “SP” can be used tosuture tissue, or perform a fascial closure. The cannula can include asingle slot. In additional embodiments, the cannula 200 a includes morethan one set of slots, and an additional suture passer or other devicecan also be inserted through guide 110 (e.g., through channel 114) andthrough cannula 200 a. This can be done while the first suture passer“SP” is at the tissue, or after the first suture passer “SP” has beenremoved. Thus, the first channel and second channel of the guide 110 isarranged and shaped so that the suture passer is directed toward aparticular slot through the cannula when the guide is properly attachedto the access device.

FIG. 5 illustrates a further embodiment of a cannula 200 b for use withsurgical access device 100. Cannula 200 b includes an inner tube 220 band an outer tuber 240 b. Inner tube 220 b is configured to fit withinouter tube 240 b, and includes at least one slot 230 b defined therein.While slot 230 b is oval-shaped in the accompanying figures, slot 230 bmay be any regular or irregular shape, such as circular, rectangular,etc. Inner tube 220 b includes a flange 232 b surrounding slot 230 b.While slot 230 b is not covered by a film in the accompanying figures,slot 230 b may be covered by a film. Flange 232 b (see FIG. 5A)protrudes from inner tube 220 b and is configured to engage or nestwithin a portion of outer tube 240 b, as discussed below.

Outer tube 240 b is configured to fit over inner tube 220 b, has ashorter length than inner tube 220 b, and includes at least one slot 250b defined therein. In embodiments, the inner tube 220 b includes twoslots 250 b that are 180° offset from each other to provide furtheroptions to the surgeon during fascial closure. Each slot 250 b is shapedto correspond with a slot 230 b of inner tube 220 b, and is configuredto radially and longitudinally align with slot 230 b of inner tube 220 bwhen outer tube 240 b and inner tube 220 b are assembled. Additionally,flange 232 b of inner tube 220 b is configured to nest within slot 250 bof outer tube 240 b when outer tube 240 b and inner tube 220 b areengaged. This helps align the inner tube 220 b and the outer tube 240 b.Thus, only one film is needed for providing an air-tight or nearlyair-tight passage. Additionally, cannula 200 b can include a balloon 300or other expandable structure at or adjacent a distal end thereof.

FIG. 6 illustrates another embodiment of a cannula 200 c for use withsurgical access device 100. Cannula 200 c includes an elongated tube 220c having channels 240 c defined within the wall of elongated tube 220 c.Elongated tube 220 c extends distally from housing 109, and includes atleast one slot 230 c defined therein. While slot 230 c is oval-shaped inthe accompanying figures, slot 230 c may be any regular or irregularshape, such as circular, rectangular, etc. In particular, slot 230 c isdefined by a recessed surface 222 c of elongated tube 220 c. Further, afilm 235 c covers slot 230 c and may be affixed to recessed surface 222c of elongated tube 220 c by welding (e.g., ultrasonic welding), forinstance, or adhesive bonding. It is envisioned that an outer surface221 c of elongated tube 220 c and film 235 c cooperate to form a flushor nearly flush surface.

Channels 240 c extend along a length (e.g., an entire length) ofelongated tube 220 c and are defined within the wall of elongated tube220 c. In particular, channels 240 c extend between outer surface 221 cand an inner surface 223 c of elongated tube 220 c. Channels 240 c arein fluid communication with balloon 300, which is mounted adjacent adistal end of elongated tube 220 c, such that when air (or anotherinflation medium) is forced from inflation port 111 of housing 109through channels 240 c, the air flows out of channel openings 242 c intoballoon 300 and inflates balloon 300. To deflate balloon 300, theinflation medium is removed from balloon 300, proximally throughchannels 240 c, and out of inflation port 111. Film 235 c helps ensurethe air/gas from the pressurized environment within the patient does notescape through the wall of elongated tube 220 c of cannula 200 c.

In embodiments where channels 240 c extend an entire length of elongatedtube 220 c, a distal end 244 c of each channel 240 c is occluded orblocked to prevent air from escaping therefrom. Including channels 240 cthat extend an entire length of elongated tube 220 c may help optimizemanufacturing of cannula 200 c. For example, elongated tube 220 c can beextruded, and channels 240 c extending the length of elongated tube 220c can be formed during the extrusion of elongated tube 220 c.

Additionally, in embodiments where cannula 200 c includes two channels240 c and two slots 230 c, channels 240 c and slots 230 c may beangularly offset from each other to prevent interference therebetween.For example, channels 240 c and slots 230 c can be offset by 90° oranother suitable angle.

In use, a distal portion of cannula 200 c is positioned within a patient(e.g., in the abdominal cavity), balloon 300 is inflated throughinflation port 111 to help secure cannula 200 c with respect to thepatient, and a surgical procedure is performed (e.g., by a surgicalinstrument inserted through a lumen 270 c of cannula 200 c). Followingthe surgical procedure, the surgical instrument is removed from lumen270 c, and the instrument seal housing is removed from engagement withhousing 109, and a portion of guide 110 is inserted through cannula 200c. Next, a suture passer “SP” (FIGS. 2 and 3) is inserted through firstchannel 112 or second channel 114 of guide 110 and at a non-parallelangle with respect to the longitudinal axis “A-A.” Thus, the suturepasser “SP” follows a different pathway from the surgical instrumentspreviously used. First channel 112 is angled such that a distal tip ofthe suture passer “SP” is moved toward slot 230 c of cannula 200 c.Urging the suture passer “SP” distally forces the distal tip of thesuture passer “SP” to pierce film 235 c covering slot 230 c of cannula200 c, and to extend out from the cannula 200 c. One or more suturepassers “SP” can be used. If cannula 200 c includes more than one slot230 c, the slots can be angularly and/or longitudinally offset from oneanother to accommodate multiple suture passers “SP.” The suture passers“SP” deliver suture to tissue at the incision, so the incision can beclosed.

FIGS. 7-8 illustrate a further embodiment of a cannula 200 d for usewith surgical access device 100. Cannula 200 d includes an inner tube220 d (FIG. 7A), an outer tuber 240 d, and a fixation mesh 260 d. Innertube 220 d is configured to fit within outer tube 240 d, and includes atleast one slot 230 d defined therein. While slot 230 d is oval-shaped inthe accompanying figures, slot 230 d may be any regular or irregularshape, such as circular, rectangular, etc. In particular, slot 230 d isdefined by a recessed surface 222 d of inner tube 220 d. Further, a film235 d covers slot 230 d and may be affixed to recessed surface 222 d ofinner tube 220 d by welding (e.g., ultrasonic welding), for instance, oradhesive bonding. It is envisioned that the outer wall of inner tube 220d and film 235 d cooperate to form a flush or nearly flush surface. Film235 d helps ensure the insufflation medium (e.g., CO₂) from apressurized environment within the patient does not escape through innertube 220 d of cannula 200 d.

Fixation mesh 260 d includes a balloon-like cover and is positionedaround (e.g., surrounding the walls of) inner tube 220 d. The cover canbe formed from an elastomeric film. The film can be molded in a shape toencourage the expansion of the mesh member 260 d.

Outer tube 240 d is configured to fit over inner tube 220 d, has ashorter length than inner tube 220 d, and includes at least one slot 250d defined therein. Slot 250 d is shaped to correspond to slot 230 d andis configured to radially and longitudinally align with slot 230 d ofinner tube 220 d when outer tube 240 d and inner tube 220 d areassembled. Two angularly aligned and longitudinally offset slots 250 dare provided, as shown in FIG. 7, and will be discussed in furtherdetail below.

In use, a distal portion of cannula 200 d is positioned within a patient(e.g., in the abdominal cavity), fixation mesh 260 d is deployed bymoving an activation tab 241 distally along the cannula length to expandfixation mesh 260 d and to help secure cannula 200 d with respect to thepatient. In doing this, lower slot 250 d ₁ of outer tube 240 d movesaway from slot 230 d of inner tube 220 d, and upper slot 250 d ₂ ofouter tube 240 d moves into alignment with slot 230 d. A surgicalprocedure is then performed (e.g., by a surgical instrument insertedthrough a lumen 270 d defined through guide 110 and cannula 200 d).Following the surgical procedure, the surgical instrument is removedfrom lumen 270 d, and the instrument seal housing is removed fromengagement with housing 109, and a portion of guide 110 is insertedthrough cannula 200 d. Next, a suture passer “SP” (FIGS. 2 and 3) isinserted through first channel 112 or second channel 114 of guide 110and at a non-parallel angle with respect to the longitudinal axis “A-A.”Thus, the suture passer “SP” follows a different pathway from thesurgical instruments previously used. First channel 112 is angled suchthat a distal tip of the suture passer “SP” is moved toward slot 230 dof inner tube 220 d. Urging the suture passer “SP” distally forces thedistal tip of the suture passer “SP” to pierce film 235 d covering slot230 d of inner tube 220 d, and extend through slot 250 d of outer tube240 d. Depending on the shape, size and/or orientation of fixation mesh260 d, a physician may opt to insert suture passer into patientfollowing the movement of fixation mesh 260 d to its pre-deployed orundeployed position to help prevent the distal tip of the suture passerfrom interfering with a deployed portion of fixation mesh 260 d. Afterthe distal tip of the suture passer is positioned at tissue, the suturepasser can be used to perform a fascial closure. The suture passer canextend through slot 230 d and slot 250 d ₂ when fixation mesh 260 d isnot deployed, or through slot 230 d and slot 250 d ₂ when fixation mesh260 d is deployed.

In some embodiments, inner tube 220 d and outer tube 240 d of cannula200 d include more than one angularly offset sets of slots toaccommodate more than one suture passer.

FIGS. 9 and 10 illustrate another embodiment of a cannula 200 e for thesurgical access device 100. Cannula 200 e includes an elongated tube 220e, and a fixation mesh 260 e. Elongated tube 220 e includes at least oneslot 230 e (e.g., an oval-, round-, rectangular-, or other-shaped slot)defined therein. In contrast to the embodiment of cannula 200 ddiscussed above with regard to FIGS. 7 and 8, slot 230 e is not coveredby a film, but a film may be provided in other embodiments.

Fixation mesh 260 e can include a balloon-like cover and is positionedaround (e.g., surrounding the wall of) elongated tube 220 e. Further,fixation mesh 260 e covers a substantial portion of the length ofcannula 200 e, and can be adhered or affixed to a flange 205 e ofcannula 200 e in an air-tight manner to provide an air-tight sealtherebetween. In this regard, fixation mesh 260 e helps ensure theair/gas from a pressurized environment within the patient does notescape through elongated tube 220 e of cannula 200 e.

In use, a distal portion of cannula 200 e is positioned within a patient(e.g., in the abdominal cavity), fixation mesh 260 e is deployed bymoving flange 205 e distally along the cannula length. This expandsfixation mesh 260 e to help secure cannula 200 e with respect to thepatient. A surgical procedure is performed (e.g., by a surgicalinstrument inserted through a lumen 270 e defined through guide 110 andcannula 200 e). Following the surgical procedure, the surgicalinstrument is removed from lumen 270 e, and the instrument seal housingis removed from engagement with housing 109, and a portion of guide 110is inserted through cannula 200 d. Next, a suture passer “SP” (FIGS. 2and 3) is inserted through first channel 112 or second channel 114 ofguide 110 and at a non-parallel angle with respect to the longitudinalaxis “A-A.” Thus, the suture passer “SP” follows a different pathwayfrom the surgical instruments previously used. First channel 112 isangled such that a distal tip of the suture passer “SP” is movedadjacent slot 230 e of elongated tube 220 e at a non-parallel angle withrespect to the longitudinal axis “A-A.” Urging the suture passer “SP”distally forces the distal tip of the suture passer “SP” to piercefixation mesh 260 e, and to thereby extend out from cannula 200 e. Aphysician may opt to insert suture passer “SP” into patient followingthe movement of fixation mesh 260 e to its pre-deployed or undeployedposition or may pass the suture passer through fixation mesh 260 e whileit is in the deployed state. After the distal tip of the suture passer“SP” is positioned within tissue, the suture passer “SP” can be used toperform a fascial closure or other closure or suturing of tissue.Additionally, in embodiments where elongated tube 220 e of cannula 200 eincludes more than one angularly offset slot, a second suture passer canalso be inserted through cannula 200 e.

The present disclosure also includes methods of performing a surgicalprocedure including using the fixation device (e.g., inflatable member300 or fixation mesh 260 d, 260 e) to secure the surgical access device100 within tissue, performing a surgical procedure through the cannula,removing a seal housing from housing 109, mounting guide 100 to housing109, inserting a distal portion of a suture passer through channel 112,114 of guide 110 and through a slot in the cannula 200, and performing afascial closure or other procedure on tissue. As noted above, dependingon the particular embodiment of the surgical access device 100, thefixation device can remain inflated/deployed during the fascial closure,or the fixation device can be deflated/undeployed while the fascialclosure is performed.

While the above description contains many specifics, these specificsshould not be construed as limitations on the scope of the presentdisclosure, but merely as illustrations of various embodiments thereof.Therefore, the above description should not be construed as limiting,but merely as exemplifications of various embodiments. Those skilled inthe art will envision other modifications within the scope and spirit ofthe claims appended hereto

The invention claimed is:
 1. A surgical access device, comprising: ahousing; a cannula extending distally from the housing and defining alongitudinal axis, a wall of the cannula including a first slot definedtherein; a guide engagable with the housing and defining a firstchannel, the first channel is disposed at a non-parallel angle relativeto the longitudinal axis; an expandable member disposed adjacent adistal portion of the cannula, the expandable member transitionablebetween a collapsed configuration and an expanded configuration; and alumen extending through the housing, the cannula, and the guide, thelumen being coaxial with the longitudinal axis; wherein a first surgicalinstrument is insertable through the first channel of the guide andthrough the first slot of the cannula.
 2. The surgical access deviceaccording to claim 1, wherein the wall of the cannula includes a secondslot defined therein, the first slot of the cannula disposed at a firstdistance along the longitudinal axis from the housing, the second slotof the cannula disposed at a second distance along the longitudinal axisfrom the housing, wherein the second distance is greater than the firstdistance.
 3. The surgical access device according to claim 2, whereinthe first slot is completely bound by the wall of the cannula, and thesecond slot is completely bound by the wall of the cannula.
 4. Thesurgical access device according to claim 1, wherein the cannulaincludes an inner tube and an outer tube.
 5. The surgical access deviceaccording to claim 4, wherein the inner tube defines the first slot, andwherein the outer tube defines an outer tube slot, the first slot andthe outer tube slot being aligned with each other.
 6. The surgicalaccess device according to claim 5, further comprising a film coveringat least one of the first slot and the outer tube slot.
 7. The surgicalaccess device according to claim 6, wherein the film is adhered to arecessed surface of at least one of the inner tube and the outer tube.8. The surgical access device according to claim 1, further comprisingat least one channel disposed within the wall of the cannula.
 9. Thesurgical access device according to claim 8, wherein the at least onechannel extends between a proximal portion of the cannula and the distalportion of the cannula.
 10. The surgical access device according toclaim 8, wherein the at least one channel is radially offset from thefirst slot.
 11. The surgical access device according to claim 1, whereinthe expandable member includes a fixation mesh.
 12. The surgical accessdevice according to claim 1, wherein the expandable member includes aballoon fixation device.
 13. The surgical access device according toclaim 1, wherein the cannula includes an inner tube and an outer tube,and wherein the expandable member includes a balloon fixation device.14. The surgical access device according to claim 13, wherein thehousing includes an inflation port disposed in fluid communication withthe balloon fixation device.
 15. The surgical access device according toclaim 14, wherein a space between the inner tube and the outer tube isdisposed in fluid communication with the inflation port and with theballoon fixation device.
 16. The surgical access device according toclaim 1, wherein the wall of the cannula is formed from an inner tubeand an outer tube, the inner tube defining the first slot, the outertube defining a second slot and a third slot, the second slot beinglongitudinally offset from the third slot, the expandable member being amesh member that expands upon movement of the outer tube distally from afirst position to a second position, the first slot of the inner tubebeing aligned with the second slot in the first position, the first slotof the inner tube being aligned with the third slot in the secondposition.
 17. The surgical access device according to claim 1, whereinan entirety of the lumen is coaxial with the longitudinal axis.
 18. Thesurgical access device according to claim 1, wherein a proximal end ofthe first channel extends through a proximal end of the housing.